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    Preventive Effect of Phosphodiesterase Inhibitor Pentoxifylline Against Medication-Related Osteonecrosis of the Jaw: An Animal Study
    (W B Saunders Co-Elsevier Inc, 2017) Yalcin-Ulker, Gul Merve; Cumbul, Alev; Duygu-Capar, Gonca; Uslu, Unal; Sencift, Kemal
    Purpose: The aim of this experimental study was to investigate the prophylactic effect of pentoxifylline (PTX) on medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: Female Sprague-Dawley rats (n=33) received zoledronic acid (ZA) for 8 weeks to create an osteonecrosis model. The left mandibular second molars were extracted and the recovery period lasted 8 weeks before sacrifice. PTX was intraperitoneally administered to prevent MRONJ. The specimens were histopathologically and histomorphometrically evaluated. Results: Histomorphometrically, between the control and ZA groups, there was no statistically significant difference in total bone volume (P=.999), but there was a statistically significant difference in bone ratio in the extraction sockets (P<.001). A comparison of the bone ratio of the ZA group with the ZA/PTX group (PTX administered after extraction) showed no statistically significant difference (P=.69), but there was a statistically significant difference with the ZA/PTX/PTX group (PTX administered before and after extraction; P=.008). Histopathologically, between the control and ZA groups, there were statistically significant differences for inflammation (P=.013), vascularization (P=.022), hemorrhage (P=.025), and regeneration (P=.008). Between the ZA and ZA/PTX groups, there were no statistically significant differences for inflammation (P=.536), vascularization (P=.642), hemorrhage (P=.765), and regeneration (P=.127). Between the ZA and ZA/PTX/PTX groups, there were statistically significant differences for inflammation (P=.017), vascularization (P=.04), hemorrhage (P=.044), and regeneration (P=.04). Conclusion: In this experimental model of MRONJ, it might be concluded that although PTX, given after tooth extraction, improves new bone formation that positively affects bone healing, it is not prophylactic. However, PTX given before tooth extraction is prophylactic. Therefore, PTX might affect healing in a positive way by optimizing the inflammatory response. (C) 2017 American Association of Oral and Maxillofacial Surgeons
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    Use of Leukocyte-rich and Platelet-rich Fibrin (L-PRF) Adjunct to Surgical Debridement in the Treatment of Stage 2 and 3 Medication-Related Osteonecrosis of the Jaw
    (Lippincott Williams & Wilkins, 2023) Yalcin-Ulker, Gul Merve; Duygu, Gonca; Tanan, Gamze; Cakir, Merve; Meral, Deniz Gokce
    Medication-related osteonecrosis of the jaw (MRONJ) is characterized by exposed necrotic bone persisting for more than 8 weeks in the maxillofacial region in patients using antiresorptive or antiangiogenetic drugs for several treatment options like bone metastasis or osteoporosis. There are several treatment options studied in scientific literature, and one of them with promising results is using platelet concentrates adjunct to surgical therapy. The aim of this study is to examine the therapeutic effect of leukocyte and platelet-rich fibrin (L-PRF) on patients with MRONJ. This 2-centered study investigated patients referred to oral and maxillofacial surgery departments of 2 university clinics between the years 2014 and 2020 with the diagnosis of MRONJ. Demographic data, the indication of the drug usage, drug type, duration, administration route, and systemic comorbidities of the patients were recorded. L-PRF was applied to 20 osteonecrotic lesions of 19 patients following surgical debridement. The male/female ratio was 5/14. Except 1 of the patients, all of the indications of medication were neoplasia-related. The mean follow-up period of patients was 27.9 & PLUSMN;9.2 months. Most common antirezorptive drug was zoledronate (84.2%). Complete resolution was observed in 16 necrosis sites (80%). It could be concluded that the use of L-PRF may represent an important adjunct in the surgical management of MRONJ.